BIOETICS IN THE CONTEXT OF THE COVID-19 PANDEMIC

Abstract

Scientific investigation and publishing has gone to unprecedented length due to the COVID/19 pandemic. To June 2020, 42 700 academic articles about COVID-19 were published¹. Being this an emerging multifaceted disease, new discoveries arise at the same time as they are studied, which present more questions than answers.

More time and research is needed to learn all the clinical and epidemiological edges of the disease as well as the long term repercussions and consequences. Hence, precipitated conclusions and deductions must be avoided.

At the same time that the need for investigations exists in order to generate evidence about best practices, COVID-19 patients must be attended. In the absence of an effective treatment, compassionate use of certain treatments has been allowed, even if these are still on trial². Both processes, research and patient care, go side by side within the pandemic.  

This is a calling to health professionals who are taking clinical decisions at every moment. Recalling the teaching of William Osler: The good doctor treats the illness; the great doctor treats the patient who suffers the illness³. Benefit/risk must be assessed for each personal medical history and only those interventions that are supported by enough scientific evidence, must be prescribe, assuring efficacy and security, with the less harm possible.

Evidence based medicine aids in reasoned decision making, nevertheless, critical analysis by readers is required. However, untested interventions are not always developed within the framework of research protocols. In light of the dynamics of this pandemic, updating and refreshing the patients’ management protocols is a moral imperative, as well as the inclusion of science and bio-ethics in the difficult medical decisions.    

Bio-ethics plays an important role in these cases, agreed that it is understood as the science that connect values and moral principles of medicine in all their dimensions⁴, clarifying ethical dilemmas throughout the bio-ethics committees.

Along the history of science, international agreements have been developed regarding bio-ethics guidelines which are reflected in different declarations such as the ones from UNESCO. In ordinary conditions, health interventions are tested in scientific investigations², and ethics committees must ensure the ethics guidelines of the Helsinki Declaration are respected and research adhered to the objective of investigation on human beings. This is to understand the causes, evolution and effects of illnesses, through scientific investigation to make them secure, efficient, effective, accessible and with high quality⁵.

For this pandemic, WHO has provided recommendations for the untested interventions that are not included in an investigation in curse, could be ethically accepted. This implies there is a justification, whether there is not a tested treatment available or funds for research. Other criteria to take into consideration is the availability of ethical and regulatory supervision, accepted by the national authority and the existence of an ethics committee and must include a patient informed consent. Also, a contribution to generate evidence must be present². Notwithstanding, dignity, confidentiality of patients and autonomy must be observed as a human rights and part of the fundamental liberties⁶.

Revista Alerta adheres the Helsinki Declaration and the UNESCO’s Universal Declaration of Bioethics and Human Rights (2005), making clear the respect and wellbeing of participating humans is of outmost importance over the interest of science and society⁶. In addition, to protect the vulnerable population groups, without biases⁵, discrimination and stigmatization⁶.  

The COVID-19 pandemic has prioritized the research in the public health field. Researchers have positively cooperated among themselves at international level. Publications have increased and opened to the public. Nevertheless, science face other risks, given the need for updated publications, renowned journals have faced the difficult position of retracting articles⁹. Also, spaces for dissemination of news without scientific background have opened, with methodological deficiencies and untested recommendations that post a danger to the public. The scientific Journals have a responsibility to deliver scientific information based on evidence, bearing in mind that quality is of outmost importance.      

Thus, Revista Alerta seeks to promote and develop a culture of scientific publication based on bioethics, professionalism, honesty and integrity which are the characteristics of science.